A comparative study on transradial vs transfemoral artery access for primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.

Transradial Versus Transfemoral Approach for Percutaneous Coronary Intervention in Elderly Patients in China： A Retrospective Analysis

Objective To compare hospital costs and clinical outcomes between transradial intervention （TRI） and transfemoral intervention （TFI） in elderly patients aged over 65 years. Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention （PCI） in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting （IPW） model was introduced to control potential biases. Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 （95%CI： CNY4419-10 420）. Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay （1.9 days, 95%CI： 1.1-2.7 days）, shorter post-procedural stay （0.7 days, 95%CI： 0.3-1.1 days）, and fewer major adverse cardiac events （adjusted odds ratio = 0.47, 95%CI： 0.31-0.73）. There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI （P〉0.05）. Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.

Effectiveness and feasibility of transradial approaches for primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective： To evaluate the efficacy and feasibility of the transradial approach for primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction（AMI）. Methods： 195 patients with acute myocardial infarction were randomly divided into two groups according to the different PCI operation pathways. 105 cases were assigned to the transfemoral artery group and 90 cases to the transradial artery group. We analyzed the data from the two groups, including the achievement ratio of paracentesis, cannulation time, the time from local anesthesia to the first time balloon inflation, the time of the total procedure, achievement ratio of PCI, incidence rate of vascular complications, total duration of hospitalization, and the six-month follow-up results in both groups. Results： Our results showed that the achier ement ratio of arteriopuncture, cannulafion time and the time from local anesthesia to the first time balloon inflation in the transradial and transfemoral groups were 98.9% vs. 100%, 3.15 ± 1.56min vs. 2.86 ± 0.97 min, and 18.56 ± 4.37 min vs. 17.75 ± 3.21 min, respectively. These differences between the two groups were not statistically significant. The total operating time was 29.75 ± 4.38 rain for the transradial group and 27.89 ± 3.95 min（P 〈 0.05） for the transfemoral group. The operation achievement ratio in the transradial group was 96.7%, and 96.2% in the transfemoral group. The incidence of puncture point complications was 2.2% in the transradial group and 11.4% in the transfemoral group, and this difference was significant. The duration of hospitalization was 10.56 ± 2.85 days for the transradial group and 13.78 ± 3.15 days（P 〈 0.05） for the transfemoral group. At the six-month follow-up, the rate of survival without cardiac event was 86.1% vs. 86.4% respectively in the transradial and transfemoral groups（P 〉 0.05）. Conclusion： The transradial approach was as effective as the transfemoral approach, and there were fewer puncture point complications as well as a shorter span of hospitalization in the transradial group. PCI via the transradial approach is safe, effective and feasible in patients with AMI.

Comparison of distal radial artery access and conventional transradial access for percutaneous coronary intervention

Background Distal radial artery access(DRA)has emerged as an alternative to conventional transradial access(TRA)for percutaneous coronary interventions(PCI).This study aims to compare the efficacy and safety of DRA versus TRA.Methods A total of 873 participants were enrolled,divided into the DRA group(n=236)and the TRA group(n=637).The primary endpoint was the success rate of access puncture.Secondary endpoints included procedural efficiency,patient comfort,and complication rates.Baseline characteristics,procedural data,and outcomes were analyzed and compared between the two groups.Results The success rates for access puncture showed no significant statistical difference between the DRA and TRA groups.However,the DRA group required more puncture attempts.DRA showed significant advantages,including shorter hemostasis times,reduced access puncture and postprocedural pain,and lower incidences of radial artery occlusion(2.1%vs.6.1%,P=0.043)and hematoma(1.7%vs.5.2%,P=0.037).Conclusions DRA is a viable alternative to TRA for performing PCI,offering comparable success rates and procedural efficiency with improved patient comfort and reduced complications.

A comparison of transradial and transfemoral approaches for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients in a high volume percutaneous coronary intervention center

Background Large percutaneous coronary intervention （PCI） centers have shown statistically better prognosis with transradial approach （TRA） compared with transfemoral approach （TFA）. So we tried to compare the outcomes between TRA and TFA in one high volume PCI center in ST-segment elevation myocardial infarction （STEMI） patients undergoing primary PCI. Method Six hundred and sixty two STEMI patients who underwent primary PCI with stents implantation were retrospectively included from June 1, 2006 to April 30, 2011 in our hospital and prospectively followed for one year. The primary endpoint was defined as in-hospital net adverse clinical events （NACE） which included death, myocardial infarction （MI）, stroke, target vessel revascularization （TVR） and major bleeding. The secondary endpoint was defined as 1 year major adverse cardiovascular events （MACE） which included death, MI and TVR. Results The occurrence rates of NACE （8.0% vs. 17.0%, P = 0.0018）, access site complications （4.0% vs. 10.7% P = 0.0027） and access site-related major bleeding （2.4% vs. 6.3%, P = 0.0254） were all higher in the TFA group than in the TRA group. The incidence rate of 1 year MACE was similar between TRA and TFA （8.5% vs. 13.2%, P = 0.0932）. The inverse probabilities weighting matched multivariable Cox regression analysis showed TRA was an independent predictor of lower rates of in-hospital NACE （HR： 0.58, 95% CI： 0.34-0.99, P = 0.0477）, in-hospital death （HR： 0.31, 95% CI： 0.10-0.73, P = 0.0499） and access site complications （HR： 0.37, 95% CI： 0.19-0.73, P = 0.0040）. Conclusions TRA showed great efficacy and safety for STEMI patients undergoing primar-y PCI in high volume PCI centers. It should be recommended as routine practice in future, and especially in those patients with high risk of bleeding.

Effectiveness and Feasibility of Transradial Approach for Primary Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

Objectives To evaluate the effectiveness and feasibility of transradial approach for primary, emergency percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）. Methods One hundred and ninety five patients with AMI undergone primary PCI were randomized into two groups using different catheter insertion pathways ： 105 cases by transfemoral approach and 90 cases by transradial approach. We compared data of different operating approaches in terms of success rate of access, cannulation time, the time from local anesthesia to the first balloon inflation, the total procedure time, success rate of PCI, access site complications, total duration of hospitalization, and the clinical outcomes at six-month follow-up. Results The success rate of artery puncture, cannulation time, and the time from local anesthesia to the first balloon inflation in the transradial and transfemoral groups were 98.9 % vs 100 % （P 〉0. 05）, 3.15 ± 1.56 minutes vs 2. 86 ± 0.97 minutes （P 〉0. 05）, and 18.56 ± 4. 37 minutes vs 17.75± 3.21 minutes （P 〉 0. 05 ）, respectively. Although the total procedure time was significantly shorter in the transfemoral group （27.89 ± 3.95 minutes） than in the transradial group （29.75 ±4. 38 minutes） （P 〈0. 05）, the overall PCI success rate was similar between the two groups （96.2 % vs 96. 7 % ）. Use of the transradial approach was associated with fewer access site complications （ 2. 2 % vs 11.4 %, P 〈 0. 05 ） and a shorter length of hospital stay （ 10. 6 days vs 13.8 days, P 〈 0. 05 ）. At six-month follow-up, the cumulative cardiac event-free survival rate was 86. 1% and 86. 4% （P 〉 0. 05 ）, respectively, in the transradial and transfemoral groups. Conclusions Transradial approach achieved similar effectiveness as transfemoral approach in emergency PCI. However, the use of the transradial approach decreased access complications and hospital stay. Primary PCI via transradial approach is safe, effective, and feasible in patients with AMI.

早期下床活动对经桡动脉行冠状动脉介入术患者应用效果的Meta分析

目的系统评价经桡动脉行冠状动脉介入术患者术后早期下床活动的效果。方法检索1993年1月1日至2023年12月31日发表在Cochrane Library、PubMed、Web of Science、Embase、中国知网、中国生物医学文献数据库、维普资讯网、万方数据库和国内外临床试验注册中心有关经桡动脉行冠状动脉介入术后早期下床活动的试验性研究,对纳入研究进行质量评价,采用RevMan 5.3软件进行Meta分析。结果最终纳入12项研究,Meta分析结果显示,与常规康复相比,经桡动脉行冠状动脉介入术后早期下床活动有利于改善患者左室射血分数[MD=4.35,95%CI(1.96,6.74),P<0.01];能提高患者生活质量[SMD=2.56,95%CI(1.37,3.75),P<0.01];增强患者日常生活能力[MD=3.78,95%CI(1.87,5.69),P<0.01];降低心绞痛[OR=0.35,95%CI(0.16,0.79),P=0.01]、心律失常[OR=0.33,95%CI(0.15,0.70),P<0.01]和心力衰竭[OR=0.35,95%CI(0.13,0.91),P=0.03]发生率;对改善冠状动脉再狭窄[OR=0.28,95%CI(0.07,1.16),P=0.08],左室舒张末内径[MD=-1.53,95%CI(-4.58,1.53),P=0.33]和6分钟步行距离[MD=32.87,95%CI(-2.03,67.77),P=0.06]效果不显著。结论早期下床活动可以明显改善经桡动脉行冠状动脉介入术后患者的心功能,提高其生活质量和日常生活能力,减少并发症,促进患者的康复。

两种桡动脉通路在经皮冠状动脉介入治疗中的可行性及安全性对比

目的:比较两种桡动脉通路在经皮冠状动脉介入治疗(PCI)中的可行性及安全性。方法:选择2020年9月—2022年12月玉环市第二人民医院内二科收治的120例行PCI患者。采用随机数表法分为两组,各60例,鼻烟窝区组选择远端桡动脉入径(TRA)即鼻烟窝处作为穿刺点,常规组选择经典TRA。比较两组的穿刺成功率、桡动脉痉挛发生率、手臂疼痛程度及术后并发症发生率。结果:两组术中均未发生桡动脉痉挛的情况;鼻烟窝区组手臂疼痛程度低于常规组,穿刺成功率高于常规组,差异有统计学意义(P<0.05)。鼻烟窝区组术后并发症总发生率为6.67%,低于常规组的16.67%,差异有统计学意义(P<0.05)。结论:经鼻烟窝区穿刺行PCI可以提高穿刺成功率,减轻患者术后手臂疼痛程度,降低术后并发症发生率。

经桡动脉行PCI术联合术后伊伐布雷定对冠心病患者疗效及对冠脉再狭窄发生率、血清ET水平的影响

目的探讨经桡动脉行PCI术联合术后伊伐布雷定对冠心病患者疗效及对冠脉再狭窄发生率、血清内皮素(Endothelin,ET)水平的影响。方法选取2021年1月—2022年8月贵州省纳雍县人民医院经桡动脉行PCI术的120例冠心病患者为研究对象,按照随机数表法分为对照组和观察组,各60例。对照组术后给予常规治疗,观察组在此基础上联合伊伐布雷定治疗。比较两组患者的临床资料、手术指标、疗效(有效率、炎性反应、复发心绞痛率)、冠脉再狭窄发生率及血清ET水平。结果与对照组(76.67%)相比,观察组的治疗有效率(93.33%)更高,差异有统计学意义(χ^(2)=6.614,P<0.05);观察组的C-反应蛋白、白细胞计数、心绞痛复发率、冠脉再狭窄率、血清ET水平均低于对照组,差异有统计学意义(P均<0.05)。结论经桡动脉行PCI术联合术后伊伐布雷定能够提高冠心病患者的临床疗效,降低冠脉再狭窄发生率,降低血清ET水平。

优质护理在经桡动脉穿刺冠状动脉介入术后患者中的应用效果观察

目的:观察优质护理在经桡动脉穿刺冠状动脉介入术后患者中的应用效果。方法:选取2021年6月—2023年8月于首都医科大学附属北京友谊医院平谷区医院接受经桡动脉穿刺冠状动脉介入术治疗的患者90例为研究对象,采用随机数字表法分为常规组与观察组,各45例。常规组术后实施常规护理,观察组在常规组基础上实施优质护理。比较两组遵医行为、健康知识知晓情况、术后并发症发生情况、焦虑情绪、生活质量。结果:护理后,两组遵医行为、健康知识知晓评分提高,观察组高于常规组(P<0.05);观察组术后并发症总发生率低于常规组(P=0.024);护理后,两组焦虑自评量表评分降低,健康状况调查简表评分升高,观察组优于常规组(P<0.05)。结论:给予经桡动脉穿刺冠状动脉介入术后患者行优质护理,可有效改善其遵医行为及健康知识知晓情况,降低并发症发生风险,缓解焦虑情绪,提高生活质量。

经皮冠状动脉介入经远端桡动脉入路穿刺成功的影响因素分析

目的:分析经皮冠状动脉介入经远端桡动脉入路(dTRA)穿刺成功的影响因素。方法:选取2021年4月—2022年7月中国医学科学院阜外医院收治的拟选择dTRA行经皮冠状动脉介入的患者268例为研究对象。入院期间均行经皮冠状动脉介入治疗。统计经皮冠状动脉介入dTRA穿刺成功情况,分析经皮冠状动脉介入dTRA穿刺成功的影响因素。结果:经皮冠状动脉介入dTRA穿刺成功233例,穿刺失败35例。两组年龄、性别、吸烟史、高血压、糖尿病、慢性肾功能不全、外周动脉疾病、甘油三酯、血红蛋白、血小板、升主动脉内径、抗栓药物应用情况比较,差异无统计学意义(P>0.05);穿刺成功组体质量指数、左心室射血分数(LVEF)、远端桡动脉内径高于穿刺失败组,心房颤动率、远端桡动脉穿刺史占比及血肌酐(Scr)、低密度脂蛋白胆固醇(LDL-C)水平低于穿刺失败组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,心房颤动、远端桡动脉穿刺史、Scr、LDL-C、LVEF、远端桡动脉内径是影响经皮冠状动脉介入远端桡动脉穿刺成功的因素(P<0.05)。结论:心房颤动、远端桡动脉穿刺史、Scr、LDL-C、LVEF、远端桡动脉内径是影响经皮冠状动脉介入dTRA穿刺成功的因素。

Safety and efficacy of transulnar approach for coronary angiography and intervention

Background Transradial approach, which is now widely used in coronary angiography and intervention, may be advantageous with respect to the femoral access due to the lower incidence of vascular complications. Transulnar approach has been proposed for elective procedures in patients not suitable for transradial approach. The objective of this study was to evaluate the safety and efficacy of the transulnar approach versus the transradial approach for coronary angiography and intervention. Methods Two hundred and forty patients undergoing coronary angiography, followed or not by intervention, were randomized to transulnar （TUA） or transradial approach （TRA）. Doppler ultrasound assessments of the forearm vessels were scheduled for all patients before procedures, 1 day and 30 days after procedures. The primary end point was access site vascular complications during hospitalization and 30 days follow-up. Major adverse cardiac events （MACE） as secondary end point was recorded till 30 days follow-up. Results Successful puncture was achieved in 98.3% （118/120） of patients in the TUA group, and in 100% （120/120） of patients in the TRA group. Coronary angiographies were performed in 40 and 39 patients in TUA and TRA group. Intervention procedures were performed in 78 and 83 patients in TUA and TRA group, respectively. The incidence of artery stenosis 1 day and 30 days after procedures was 11.0% vs.12.3% and 5.1% vs. 6.6% in TUA and TRA group, respectively. Asymptomatic access site artery occlusion occurred in 5.1% vs.1.7% of patients 1 day and 30 days after transulnar angioplasty, and in 6.6% vs. 4.9% of patients 1 day and 30 days after transradial angioplasty. Minor bleeding was still observed at the moment of the ultrasound assessment in 5.9% and 5.7% of patients in TUA and TRA group, respectively （P=0.949）. No big forearm hematoma, and A-V fistula were observed in both groups. Freedom from MACE at 30 days follow-up was observed in all patients. Conclusions The transulnar approach is as safe and effective as the transradial approach for coronary angiography and intervention. It is an attractive opinion for experienced operators who are skilled in this technique, particularly in cases of anatomic variations of the radial artery, radial artery small-caliber or thin radial pulse.

非阻断血流压迫止血法在冠状动脉介入诊疗术后患者中的应用

目的探讨行非阻断血流压迫止血法对经桡动脉途径冠状动脉介入诊疗术(TRI)后桡动脉闭塞(RAO)发生率的影响。方法将2020年12月-2022年2月择期的349例患者随机分为观察组(174例)和对照组(175例)。对照组术后采用常规气囊式桡动脉止血器压迫止血护理,观察组术后回房时实施非阻断血流压迫止血,再进行常规压迫止血护理,观察2组患者术后RAO、出血发生率及血氧饱和度及疼痛评分情况。结果与对照组相比,观察组患者术后48 h、1个月RAO发生率均明显低于对照组,且差异有统计学意义(P<0.05);2组患者出血发生率差异无统计学意义(P>0.05);观察组患者回房时、术后1 h、3 h血氧饱和度明显高于对照组,差异有统计学意义(P<0.05);观察组患者术后1 h、3 h、6 h疼痛评分明显低于对照组,差异有统计学意义(P<0.05)。结论非阻断血流压迫止血法能在确保止血效果的基础上降低患者RAO发生率,提高舒适度,值得临床推广应用。

两种远端桡动脉通路在冠状动脉造影及介入治疗中的可行性及安全性

目的对两种远端桡动脉通路在冠状动脉造影及介入治疗中的可行性及安全性进行比较,以期为临床工作提供参考依据。方法选取2022年2月至2022年5月于济宁市第一人民医院行冠状动脉造影(coronary angiography,CAG)及介入治疗的患者445例,采用随机数字表法分为合谷穴组220例和解剖鼻烟窝(anatomical snuffbox,AS)组225例,比较两组的穿刺情况、手术完成率及并发症发生率。结果两组在穿刺成功率、穿刺时间、手术完成率、桡动脉痉挛、出血、水肿等方面差异均无统计学意义(P>0.05);合谷穴组桡神经损伤发生率低于AS组(0%vs 3.1%,P<0.05),疼痛数字评分(numeric rating scale,NR)合谷穴组高于AS组(2.21±1.33 vs 1.93±1.36,P<0.05)。结论相较AS内桡动脉穿刺,合谷穴内桡动脉穿刺可降低术后桡神经损伤发生率,具有更高的安全性,但疼痛增加降低了患者的舒适度。

经远端桡动脉入径在冠状动脉造影及介入治疗中的应用

目的 探讨经远端桡动脉入径在冠状动脉造影及介入治疗中的应用价值。方法 选择住院期间行冠状动脉造影术的患者600例为研究对象,随机分为试验组(经远端桡动脉入径,n=300)和对照组(常规经桡动脉入径,n=300)。比较2组主要危险因素、穿刺成功率、术中及术后并发症(出血或血肿、假性动脉瘤、水泡、动脉闭塞)的发生情况。结果 2组患者性别、年龄、高血压、糖尿病、高脂血症、体质量指数比较,差异无统计学意义(P>0.05)。试验组较对照组穿刺成功率低、穿刺时间长,差异有统计学意义(P<0.05);试验组总并发症发生率为2.3%,低于对照组的11.7%,差异有统计学意义(P<0.05)。结论 经远端桡动脉入径具有安全性高、术后并发症少、患者舒适度高等优点,为预防桡动脉闭塞提供了很好的方法。

两种桡动脉入径行冠脉介入诊疗效果比较

目的对比分析经鼻烟窝区远端桡动脉入径(dTRA)和常规桡动脉入径(TRA)行冠脉介入诊疗效果。方法回顾性分析武警特色医学中心心血管病科2021-01至2022-12收治冠心病行CAG和(或)PCI诊疗的患者临床资料182例,筛选出145例,其中68例经鼻烟窝区远端桡动脉入径(dTRA组),77例经常规桡动脉入径(TRA组)。比较两组患者术前基线资料,术中一次性穿刺成功率、穿刺置管时长;术后穿刺部位加压止血时间、术区疼痛,肢体舒适度、术后并发症及患者满意度等观察指标。结果两组患者的术前基线资料对比无统计学差异。dTRA组一次性穿刺成功56例(82.35%),TRA组成功71例(92.21%),两组一次性穿刺成功率差异无统计学意义(χ^(2)=3.225,P=0.083)。与TRA组相比,dTRA组完成穿刺置管所需时间较长[(18.72±3.29)minvs.(8.87±2.72)min,t=-19.705,P<0.001],但术后压迫止血时间明显减少[(2.40±0.49)hvs.(5.72±0.61)h,t=35.853,P<0.001],差异均有统计学意义。与TRA组相比,dTRA组的术肢疼痛明显减轻(P<0.001),术后并发症显著减少(P<0.05),且主要表现为术后血肿,偶有假性动脉瘤,未发生桡动脉闭塞,患者对手术的满意度高于TRA组(非常满意,22.06%vs.1.30%;满意,75.00%vs.86.61%;不满意,2.94%vs.9.09%;P<0.001),差异均有统计学意义(P<0.05)。结论dTRA穿刺术式有利于患者的术后恢复、减少并减轻并发症,但因技术难度较高,在临床推广中需注意技术培训。

经桡动脉入径与腕背支动脉入径穿刺行经皮冠脉介入治疗的疗效比较

目的比较经桡动脉入径(TRA)穿刺与腕背支动脉入径(DCAA)穿刺行经皮冠脉介入治疗(PCI)的优缺点,观察PCI术后应用硫酸氢氯吡格雷和替格瑞洛对并发症发生率的影响。方法选择沧州市人民医院2020年11月至2021年4月确诊为冠心病需行PCI的128例患者作为研究对象。根据桡动脉穿刺入路不同将患者分为TRA组(65例)和DCAA组(63例),TRA组穿刺成功64例(穿刺成功率98.46%);DCAA组穿刺成功56例(穿刺成功率88.89%),最终TRA组纳入64例,DCAA组纳入56例。比较两组穿刺时间、术后出血时间的差异;再将PCI术后患者按服用血小板抑制药物不同分为硫酸氢氯吡格雷组和替格瑞洛组,观察术后使用硫酸氢氯吡格雷和替格瑞洛对穿刺部位并发症(如出血、血肿、动脉闭塞、血栓)发生率的影响。结果TRA组穿刺时间较DCAA组明显缩短(s:154.95±3.93比168.16±5.24,P<0.05),术后出血时间较DCAA组明显延长(s:278.78±4.53比142.25±1.54,P<0.05)。DCAA组术后应用硫酸氢氯吡格雷治疗后血肿发生率较应用替格瑞洛明显升高〔10.71%(3/28)比0%(0/28),P<0.05〕;TRA组应用硫酸氢氯吡格雷治疗后血肿、动脉闭塞、血栓发生率均较应用替格瑞洛明显升高〔18.75%(6/32)比3.13%(1/32)、9.38%(3/32)比0%(0/32)、12.50%(4/32)比0%(0/32),均P<0.05〕,应用硫酸氢氯吡格雷和替格瑞洛后两组均无出血事件发生。结论DCAA是一种安全可行的新型PCI入路方式,为患者和PCI医生提供了其他选择,在患者舒适度方面更有优势。替格瑞洛和硫酸氢氯吡格雷均有血小板抑制作用,且替格瑞洛的血小板抑制作用优于硫酸氢氯吡格雷,应用替格瑞洛在血肿、桡动脉闭塞及血栓等并发症发生率方面相对较低,而在出血事件方面,替格瑞洛和硫酸氢氯吡格雷无差异。

经桡动脉途径介入治疗老年冠心病合并慢性心力衰竭的疗效观察

目的观察老年冠心病合并慢性心力衰竭应用经桡动脉途径介入治疗的临床疗效。方法50例老年冠心病合并慢性心力衰竭患者,随机分为实验组和对比组,各25例。对比组应用经股动脉途径介入治疗,实验组应用经桡动脉途径介入治疗。比较两组患者临床疗效、手术指标、术后并发症发生情况及治疗前后美国纽约心脏病学会(NYHA)心功能分级、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、心率、左室射血分数(LVEF)、心输出量(CO)、每搏输出量(SV)、舒张早期心室充盈速度峰值(E峰)与舒张晚期心室充盈速度峰值(A峰)的比值(E/A)、N末端B型利钠肽前体(NT-proBNP)、血压、心理状态、生活质量、炎症因子指标[超敏C反应蛋白(hs-CRP)、B型脑利钠肽(BNP)]、血管内皮功能指标[一氧化氮(NO)、内皮素-1(ET-1)、肱动脉非内皮依赖性血管舒张功能(NMD)、肱动脉血流介导的血管舒张功能(FMD)、肱动脉峰值流速变化率]及6 min步行试验(6MWT)。结果实验组患者治疗总有效率92.00%高于对比组的68.00%,差异有统计学意义(P<0.05)。两组患者手术时间比较差异无统计学意义(P>0.05);实验组患者穿刺时间(4.36±1.26)min、X线曝光时间(41.16±8.37)min、术后卧床时间(3.16±1.05)d及住院时间(7.53±1.10)d均短于对比组的(11.97±1.51)min、(48.84±8.53)min、(6.72±1.53)d、(13.51±2.17)d,差异有统计学意义(P<0.05)。治疗后,两组患者NYHA心功能分级、LVESD、LVEDD、心率均优于本组治疗前,差异有统计学意义(P<0.05)。治疗后,两组患者LVEF、CO、SV均优于本组治疗前,差异有统计学意义(P<0.05)。治疗后,两组患者E/A、NT-proBNP均优于本组治疗前,差异有统计学意义(P<0.05);两组患者收缩压、舒张压与治疗前比较,差异无统计学意义(P>0.05)。治疗后,实验组患者E/A(1.23±0.08)优于对比组的(0.94±0.11),差异有统计学意义(P<0.05);两组患者NT-proBNP、收缩压、舒张压比较差异无统计学意义(P>0.05)。治疗后,两组患者焦虑自评量表评分、抑郁自评量表评分及健康调查简表(SF-36)评分均优于本组治疗前,且实验组患者焦虑自评量表评分(43.20±6.45)分、抑郁自评量表评分(46.44±5.93)分及SF-36评分(65.03±8.16)分均优于对比组的(50.94±6.76)、(61.44±5.83)、(58.46±8.82)分,差异有统计学意义(P<0.05)。实验组患者术后并发症发生率12.00%与对比组的20.00%比较差异无统计学意义(P>0.05)。治疗后,两组患者hs-CRP、BNP、6MWT、NO、ET-1、NMD、FMD、肱动脉峰值流速变化率均优于本组治疗前,且实验组患者hs-CRP(7.14±0.95)mg/L、BNP(389.15±31.82)ng/L、6MWT(451.36±56.17)m、NO(75.84±7.95)μmol/L、ET-1(69.35±5.22)pg/ml、NMD(16.11±2.91)%、FMD(12.01±1.23)%、肱动脉峰值流速变化率(68.34±6.34)%均优于对比组的(11.81±1.48)mg/L、(460.81±38.22)ng/L、(412.61±52.72)m、(55.31±8.36)μmol/L、(81.56±5.37)pg/ml、(14.04±2.35)%、(9.38±1.47)%、(56.01±5.92)%,差异有统计学意义(P<0.05)。结论经桡动脉途径介入治疗老年冠心病合并慢性心力衰竭的疗效较经股动脉途径显著,值得临床推广。

多层CT冠脉成像对老年冠心病患者经桡动脉介入治疗疗效的评估及诊断价值研究

目的:探讨多层CT冠脉成像对老年冠心病患者经桡动脉介入治疗疗效的评估及诊断价值研究。方法:选取2021年3月至2022年3月在我院进行经桡动脉介入治疗的136例老年冠心病患者,随机将其分为观察组与对照组,每组各68例,两组患者使用多层CT冠脉成像技术进行扫描,观察组在进行手术前医生需要详细的观察CT图像,之后对其进行经桡动脉介入治疗,对照组患者直接进行介入治疗。比较两组患者的手术指标、术后恢复情况、术后并发症、出血情况以及MACCE发生率。结果:观察组患者的首次导丝通过率以及穿刺的成功率明显高于对照组患者,有统计学意义(P<0.05);观察组导丝进入假腔发生率明显的低于对照组,有统计学意义(P<0.05);观察组导丝未通过率、支架未通过率以及球囊未通过率低于对照组,没有统计学意义(P>0.05);观察组患者的手术操作时间明显低于对照组患者(P<0.05);观察组患者的加压包扎时间、住院时间以及卧床时间明显的短于对照组患者(P<0.05);观察组患者出现的迷走神经反射、肺栓塞、动脉痉挛等并发症的发生率显著的低于对照组患者(P<0.05);观察组患者的出血事件发生情况明显的低于对照组患者(P<0.05),观察组患者的MACCE发生率低于对照组患者(P>0.05)。结论:使用多层CT冠脉成像对老年冠心病患者经桡动脉介入治疗的临床疗效较好,值得在临床进行推广。

Transradial versus transfemoral percutaneous coronary interventionin elderly patients： a systematic overview and meta-analysis

Background Transradial approach(TRA) percutaneous coronary intervention(PCI) has been wildly applied among unselected patients. However, only very few small studies have compared the outcomes between TRA and transfemoral approach(TFA) in elderly patients. We aimed to evaluate the efficacy and safety between TRA and TFA in elderly patients by a pooled analysis.Methods Studies that met the inclusion and exclusion criteria were included. Statistical analysis was performed using the Review Manager 5.0.0 developed and maintained by the Cochrane Collaboration and a random-effects model was used to better account for the differences among the sub-studies. The primary endpoint was defined as short-term mortality, and other endpoints included major adverse cardiovascular events, major bleeding events, procedure success, vascular complications and hospital stay. Results Two thousand one hundred and eighty-eight patients from 11 studies were finally included. A non-significant trend toward a lower rate of short-term death was found in favor of TRA(odds ratio(OR): 0.56, 95% confidence interval(CI): 0.27–1.16). The incidence rates of vascular complications(OR 0.25, 95% CI: 0.14–0.46) and major bleeding events(OR: 0.31, 95% CI: 0.18–0.55) were greatly reduced by TRA compared with TFA. No significant difference was detected in the occurrence rate of major adverse cardiovascular events(OR: 0.77, 95% CI: 0.45–1.30), but the rate of procedure success was significantly improved by TRA(OR: 1.86, 95% CI: 1.18–2.94). In addition, the total hospital stay was also significantly reduced by TRA.Conclusions TRA showed greater efficacy and safety compared with TFA in elderly patients. It should be recommend as routine practice for elderly patients undergoing PCI in TRA capable hospitals.